Rise in Binge Drinking Worries Doctors

Television series show groups of girlfriends who get together for cosmopolitans. Ads on subways tout scotch as a glamorous beverage. Football games are sponsored by beer manufacturers.

"Alcohol is everywhere, and the media is trying to make it appealing," says Silvia Hafliger, M.D. "But it's not cool, and drinking doesn't make you sexy." She contends that such portrayal of alcohol in the media is fueling the rising incidence of binge drinking in America.

There are also health risks associated with binge drinking, and they could possibly accumulate to equal those associated with alcoholism – including damage to the liver, heart, and nervous system. "People who binge drink don't think they're alcoholics, but the health effects of recurrent binge drinking could be similar," explains Lorna Dove, M.D.

The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as a pattern of drinking that brings a person's blood alcohol concentration to 0.08 or above. This typically happens when men consume five or more drinks and when women consume four or more drinks in a two-hour period.

Contrary to what one might think, many binge drinkers are not alcoholics. They abuse alcohol, but are not dependent on it – although over time, binge drinking can lead to alcoholism, depending on what is driving the person to drink.

Lorna M. Dove, M.D.

The proportion of current drinkers who binge is highest in the 18 to 20-year-old group (51 percent). Dr. Hafliger is particularly concerned about the rising number of young women who are binge drinking. She noted, for example, that the number of students who are binge drinkers at all-female colleges rose 125 percent between 1993 and 2001. Similar increases have not been observed among college males.

"There's a feeling among young women that they have to keep up with the guys, that they can drink as much as they do," Dr. Hafliger explains. "We have to get the message out that this is not the thing to do."

Men and women drink for different reasons: Many young women self-medicate with alcohol as an escape to relieve anxiety and depression, and to deal with eating disorders. ("Drunkorexia" is a term used to describe the choice of alcohol over food when a woman is restricting her caloric intake.) There has been a spate of suburban mothers caught driving drunk with their children in the car; they may drink to ease the depression and isolation they feel if they are stuck home all day, overwhelmed by caregiving responsibilities. On the other hand, men who binge drink are more likely to do so because they are in a social situation, such as watching a ball game or hanging out at a party with buddies.

Silvia Hafliger, M.D.

But male and female bodies are different, and women cannot tolerate consuming as much alcohol as men. The adverse health effects of binge drinking may arise 20 years earlier in women than in men, and women are much more likely to die from alcohol-related complications than men.

"Frequent binge drinking may cause inflammation in the liver and fibrosis (scarring) over time, as the liver continuously repairs itself – ultimately leading to cirrhosis and possibly the need for liver transplantation," says Dr. Dove. In the cardiovascular system, binge drinking may raise blood pressure and could cause alcoholic cardiomyopathy (an inability of the heart muscle to squeeze efficiently, leading to congestive heart failure). Recurrent binge drinking may impair memory, promote dementia, and cause neuropathies (nerve disorders). It can also raise the risk of pancreatitis (inflammation of the pancreas).

The risks of binge drinking are not just medical. Women who binge drink are more likely to be date-raped, engage in unprotected sex, or become a victim of violence. In fact, alcohol is involved in 73 percent of all rapes and 70 percent of all domestic violence. And binge drinkers are 14 times more likely to report alcohol-impaired driving than non-binge drinkers.

So, what can be done? Recommended limits on alcohol consumption are no more than one drink a day for women and two for men (though this doesn't mean a person can abstain from drinking all week and consume all the beverages on the weekend).

Dr. Hafliger advises people who drink to have a plan: Set a limit on alcohol consumption, space out the drinks, and make sure to eat. People who feel like they are using alcohol to relieve stress or an emotional issue should speak with a counselor, doctor, or trusted friend or family member who can help. If someone thinks they can't live without alcohol, he or she should try abstaining from it for three weeks; if that can't be done, it may be time for Alcoholics Anonymous or another alcohol dependence program. And if someone is binge drinking to relieve stress, other outlets – such as exercise, yoga, or meditation – may help.

Contributing faculty for this article:

Silvia Hafliger, M.D. is the Transplantation Psychiatrist at the Center for Liver Disease and Transplantation at New York-Presbyterian Hospital and an Assistant Clinical Professor of Psychiatry at Columbia University College of Physicians and Surgeons.

Lorna Dove, M.D. is the Medical Director of Adult Liver Transplantation at the Center for Liver Disease and Transplantation at New York-Presbyterian Hospital and an Associate Professor of Clinical Medicine (in Surgery) at Columbia University College of Physicians and Surgeons.